As the old Rolling Stones tune goes, “Time is on my side.” For rehab therapists who bill correctly, that’s certainly true in many cases. But, as with most things RCM-related, billing correctly can be easier said than done—especially if you don’t have a team of dedicated billing experts. Between confusing payer rules and coding conundrums, it’s sometimes hard to know if you’re on the right track. But, knowing where the rest of the pack is can tell you a lot about your own billing habits—which, in turn, can help you navigate away from hot water. With that in mind, here’s what physical therapists need to know about per-visit billing averages:
What is the overall average number of units billed per visit?
According to this resource from the American Academy of Orthopaedic Surgeons, the average PT visit takes 45 to 60 minutes, which results in charges for about three and a half (3.5) weighted procedures (WPs) or one and a half (1.5) work relative value units (RVUs). Typically, 3.5 WPs per visit translates into three timed procedures and one modality. As the AAOS explains, if a PT regularly charges less than that, it could be due to one or more of the following factors:
- The therapist sees too many patients in a workday.
- The therapist does not apply all appropriate charges due, whether intentionally or unintentionally.
- The therapist does not possess the clinical skills necessary to treat each patient effectively for an appropriate amount of time.
- The therapist spends too much time on non-billable activities (e.g., education unrelated to current modalities, interaction with physicians, documentation, etc.).
- The therapist erroneously applies Medicare billing rules to non-Medicare patient claims (e.g., 8-minute rule).
That said, billing averages vary from clinic to clinic and depend on setting, patient diagnoses, and business model. A better question might be, “What is the average number of units billed per appointment in your clinic?” This should be one of the key performance indicators (KPIs) you track on a regular basis. By keeping a close eye on this KPI, you can better identify hiccups in your RCM process before they put a major dent in your financial performance.
What about average billable charges?
According to our 2017 State of Rehab Therapy report—which was based on an industry-wide survey of thousands of rehab therapy professionals—a little more than half of respondents reported an average amount billed per claim of $120 to $219. However, this number has dropped since 2017, with about 44% of respondents giving an average of $120 to $219 during our 2019 industry survey. Interestingly enough, the percentage of claims above $341 has risen each year we’ve conducted the survey, starting at 8.8% in 2017 and climbing to 13% in 2019.
Regardless of the total dollar amount of your charges, it’s important to be smart about which codes (i.e., units) are attached to those charges. In some cases, PTs choose lower-paying codes when the services they provided actually warrant higher-paying ones. As I mentioned in this post, three common billing mistakes include:
- using the wrong code (e.g., using the code for therapeutic exercise when you should’ve billed for therapeutic activities);
- underbilling fixed-rate payers; and
- miscounting timed codes.
What happens if you intentionally misbill?
This should definitely go without saying, but physical therapists should never, ever submit an intentionally fraudulent bill. This not only increases overall healthcare spending, but also saps away at taxpayer-funded programs like Medicare and Medicaid. Furthermore, the consequences for providers who are found guilty of fraudulent billing can be dire: for example, an anesthesiology practice in New York agreed to pay almost $2 million in 2017 to resolve claims it improperly billed for services that require at least 16 minutes of one-on-one time with a patient. Simply put, it’s just not worth the risk.
If you “can’t get no satisfaction” with your current billing practices, it may be time to look into what’s causing your heartache—and adjust your approach as needed. Have questions related to units, coding, or other billing stats? Drop us a line in the comment section below!